Temporal and regional mortality trends due to pulmonary embolism in patients with hematolymphoid malignancies in the United States from 1999 to 2020.

Abstract

e19087 Background: Pulmonary embolism (PE) is a significant complication and a marker of increased mortality in patients suffering from hematolymphoid malignancies, including leukemias, lymphomas, and multiple myeloma. Individuals with these hematologic cancers are at an increased risk of venous thromboembolism (VTE) due to cancer-associated hypercoagulability, treatment-related effects, and disease-related factors. Examining mortality trends is critical for informing targeted interventions and optimizing patient management. Methods: This retrospective study analyzes national mortality data from the CDC WONDER database to assess mortality trends from 1999 to 2020 across different demographic subgroups in the United States. Patients with a known history of a hematolymphoid cancer were identified and PE related mortality data was retrieved. Age-adjusted mortality rates (AAMRs) per 100,000 individuals were calculated and further stratified based on sex, age, race and census region. Rstudio was used to perform the t-test and Mann Kendall test. Results: From 1999 to 2020, a total of 12,453 deaths were reported in hematolymphoid cancer associated PE in the US (females, AAPC: 0.17 (95% CI: 0.165-0.175) vs. males AAPC: 0.256 (95% CI: 0.25-0.263)). The overall AAMR demonstrates a general upward trend with some annual fluctuations, increasing from 0.409 in 1999 to 1.022 in 2020. AAMR declined from 1999 to around 2009, reaching its nadir (τ: -0.160, p=0.321 for females, τ: 0.105, p=0.516). From 2010 onwards, a gradual increase is observed, with a sharp spike in 2020. Men consistently had a higher AAMR than women, with rates of 0.166 vs. 0.261 in 1999 and 0.223 vs. 0.31 in 2020. Black or African American females had higher AAMRs (0.228) than White females (0.164). Males followed a similar trend (0.356 vs. 0.261). AAMR also varied significantly by region, with the Midwest having the highest rate (0.219), followed by Northeast (0.214). For the age group of 16-64 years, males had consistently higher AAMR (0.065), than females (0.034), with an overall AAMR of 0.047 (p<0.001). Similar trends were seen for the age group older than 65 years (1.28 vs 0.819), which also demonstrated a higher overall AAMR (1.059) (p<0.001). In summary, Black or African American males of the age group 65+ had the highest AAMR. Conclusions: Our analysis of hematolymphoid malignancy-associated pulmonary embolism highlights a concerning increase in this near-fatal cancer-related complication, particularly after 2010, with the highest impact observed among male Black or African American patients and those residing in the Midwest region. These findings emphasize the urgent need for healthcare programs to focus on these vulnerable populations by implementing enhanced screening protocols, lowering the diagnostic threshold for PE in patients with hematolymphoid malignancies.